Active Minds gave me the
strength and power to start going to counseling. I am
proud to tell people that I have a counselor and now
encourage friends to go to counseling. I help them
understand that even if they don't have a mental illness,
they do have mental health that needs to be cared for.

Nearly 1 in 5
Americans Suffers From Mental Illness Each Year
New Jersey had the lowest rates of overall and severe mental
illness, while Utah had the highest

Every year, about 42.5 million
American adults (or 18.2 percent of the total adult
population in the United States) suffers from some mental
illness, enduring conditions such as depression, bipolar
disorder or schizophrenia, statistics released Friday
reveal.

The data, compiled by the Substance
Abuse and Mental Health Services Administration (SAMHSA),
also indicate that approximately 9.3 million adults, or
about 4 percent of those Americans ages 18 and up,
experience serious mental illness  that
is, their condition impedes day-to-day activities, such as
going to work.

This data does not diverge greatly
from the last SAMHSA report, released in 2012, which found
that 45.9 million American adults, 20 percent of this
demographic, experienced mental illness at least once
annually. (Though there is a 1.8 percent difference, the
statistics do have margins of error, and methods of
compiling them are often revised, so this dip does not
necessarily mean there has been a long-term decline in
mental illness.)

The SAMHSA paper comes amid increasing
scrutiny of the ability of Americas health care system
to handle issues of mental illness. For example, the
American Mental Health Counselors Association released a
study earlier this week claiming that adults with mental
illness who live in those states electing against expanding
Medicaid under Obamacare will be denied insurance. According
to the study, care could be denied to up to 4 million
patients.

The SAMHSA study breaks down mental
illness rates by state. Perhaps surprisingly, New Jersey had
the lowest national rates of overall and severe mental
illness  14.7 percent and 3.1 percent,
respectively.

The states with the most mental
illness?

In Utah, 22.3 percent of the adult
population experienced mental illness, and in West Virginia
had the most cases of severe mental illness among adults, at
5.5 percent.

It may be tempting to look at the map
that accompanies the study and try to make guesses at why,
say, the Pacific Northwest and the Midwest seem to suffer
more from mental illness than other regions. However,
because there is so much mental health illness in all the
states  and lots of uncontrolled variables  it
would be hard to draw any real conclusions. According to the
study, factors that potentially contribute to the
variation are not well understood and need further
study.

Not all psychiatric statisticians are
satisfied with SAMHSAs findings, with some alleging
that the agency grossly understates the prevalence of mental
illness.

Ronald Kessler, McNeil Family
Professor of Health Care at Harvard and expert in large
scale mental illness surveys, tells Newsweek that
SAMHSAs assessment of serious mental illness is
pretty good but that he believes that the
prevalence for any mental illness is too
low.

Kessler, who is familiar with
SAMHSAs computational methods, said that the agency
did not measure all of the ailments in the Diagnostic and
Statistical Manual of Mental Disorders -- including some
major ones like attention deficit disorder.

I find it objectionable that
they use this term any mental illness, he
says. What they really mean is any mental illness that
they decided to measure. What they ask about is anxiety and
depression and drinking and drugs, but there are many things
beside that they totally ignored.

Kessler estimates that the prevalence
of mental illness might range from 25 to 30 percent of
American adults. A 2011 report published by the U.S. Centers
for Disease Control and Prevention pegs the number at 25
percent.

SAMHSAs statistics division
disagrees with Kesslers assessment.

This captures the majority of
people suffering from mental illness in the country,
Dr. Kevin Hennessy, deputy director of the Center for
Behavioral Health and Statistics and Quality, tells
Newsweek. According to the report, the state-level estimates
are based on data collected from 92,400 adults 18 and over
from the 2011 and 2012 National Surveys on Drug Use and
Health. The survey itself was built around the DSM, but also
includes an improved prediction model developed
based on previous survey attempts.

Ultimately, the experts might be
splitting hairs; even the state with the lowest rate of
mental illness still nears 15 percent. Perhaps more
importantly, only 62.9 percent of adults nationwide with
serious mental illness received mental health treatment in
the year they reported this illness.

Dr. Peter Delany  director of
the the governments lead agency for behavioral
health statistics, the Center for Behavioral Health
and Statistics and Quality, according to SAMHSAs
website  tells Newsweek that the information shows
policymakers, in black and white terms, that mental illness
impacts a large portion of the population, regardless of
statistical caveats.

Talk
with your kids about Mental HealthKids are naturally curious and have questions about
mental illnesses. It can be challenging for adults as well
as for children. Myths, confusion, and misinformation about
mental illnesses cause anxiety, create stereotypes, and
promote stigma. During the past 50 years, great advances
have been made in the areas of diagnosis and treatment.
Parents can help children understand that these are real
illnesses that can be treated.

In order to talk with a child about
mental illnesses, you must be knowledgeable and reasonably
comfortable with the subject. You should have a basic
understanding and answers to questions such as, what are
mental illnesses, who can get them, what causes them, how
are diagnoses made, and what treatments are available. Some
parents may have to do a little homework to be better
informed.

Parents can help children understand
that these are real illnesses that can be treated. In order
to talk with a child about mental illnesses, you must be
knowledgeable and reasonably comfortable with the subject.
You should have a basic understanding and answers to
questions such as, what are mental illnesses, who can get
them, what causes them, how are diagnoses made, and what
treatments are available. Some parents may have to do a
little homework to be better informed.

Because children often cant
understand difficult situations on their own, you should pay
particular attention if they experience:

1. Loss of a loved one
2. Divorce or separation of their parents
3. Any major transition  new home, new school.
4.Traumatic life experiences, like living through a natural
disaster
5.Teasing or bullying
6. Difficulties in school or with classmates

Parents should be aware of their
child's needs, concerns, knowledge, and experience with
mental illnesses. When talking about mental illnesses,
parents should:

1. Communicate in a straightforward
manner
2. Communicate at a level that is appropriate to a child's
age and development level
3. Have the discussion when the child feels safe and
comfortable
4. Watch their child's reaction during the discussion
5. Slow down or back up if the child becomes confused or
looks upset
6. Listen openly and let your child tell you about his or
her feelings and worries

Considering these points will help any
child be more relaxed and understand more of the
conversation.

Pre-School Age
Children

Young children need less information
and fewer details because of their more limited ability to
understand. Preschool children focus primarily on things
they can see, for example, they may have questions about a
person who has an unusual physical appearance, or is
behaving strangely. They would also be very aware of people
who are crying and obviously sad, or yelling and
angry.

School-Age Children

Older children may want more
specifics. They may ask more questions, especially about
friends or family with emotional or behavioral problems.
Their concerns and questions are usually very
straightforward. "Why is that person crying? Why does Mommy
drink and get so mad? Why is that person talking to
himself?" They may worry about their safety or the safety of
their family and friends. It is important to answer their
questions directly and honestly and to reassure them about
their concerns and feelings.

Teenagers

Teenagers are generally capable of
handling much more information and asking more specific and
difficult questions. Teenagers often talk more openly with
their friends and peers than with their parents. As a
result, some teens may already have misinformation about
mental illnesses. Teenagers respond more positively to an
open dialogue which includes give and take. They are not as
open or responsive when a conversation feels one-sided or
like a lecture.

Talking to children about mental
illnesses can be an opportunity for parents to provide their
children with information, support, and guidance. Learning
about mental illnesses can lead to improved recognition,
earlier treatment, greater understanding and compassion, as
well as decreased stigma.

Do you need help starting a
conversation with your child about mental health? Try
leading with these questions. Make sure you actively listen
to your childs response.

1. Can you tell me more about what is
happening? How you are feeling.
2. Have you had feelings like this in the past?
3. Sometimes you need to talk to an adult about your
feelings. Im here to listen. How can I help you feel
better?
4. Do you feel like you want to talk to someone else about
your feelings?
5. Im worried about your safety. Can you tell me if
you have thoughts about harming yourself or
others?

Seek immediate assistance if you think
your child is in danger of harming themselves or others. You
can call a crisis line or the National Suicide Prevention
Line at 1.800.273.TALK (8255) or teach your chioldren the
Crisis Text Number 741741 since they probably prefer to text
about emotional issues than talk about them.

If your child is in need of community
mental health services, check out your local school health
center.

Talking
To Kids About Mental Illnesses
Kids are naturally curious and have questions about
mental illnesses. Understanding mental illnesses can be
challenging for adults as well as for children. Myths,
confusion, and misinformation about mental illnesses cause
anxiety, create stereotypes, and promote stigma. During the
past 50 years, great advances have been made in the areas of
diagnosis and treatment of mental illnesses. Parents can
help children understand that these are real illnesses that
can be treated.

Parents can help children understand
that these are real illnesses that can be treated. In order
to talk with a child about mental illnesses, you must be
knowledgeable and reasonably comfortable with the subject.
You should have a basic understanding and answers to
questions such as, what are mental illnesses, who can get
them, what causes them, how are diagnoses made, and what
treatments are available. Some parents may have to do a
little homework to be better informed.

When explaining to a child about how a
mental illness affects a person, it may be helpful to make a
comparison to a physical illness. For example, many people
get sick with a cold or the flu, but only a few get really
sick with something serious like pneumonia. People who have
a cold are usually able to do their normal activities.
However, if they get pneumonia, they will have to take
medicine and may have to go to the hospital. Similarly,
feelings of sadness, anxiety, worry, irritability, or sleep
problems are common for most people. However, when these
feelings get very intense, last for a long period of time
and begin to interfere with school, work, and relationships,
it may be a sign of a mental illness that requires
treatment.

Because children often cant
understand difficult situations on their own, you should pay
particular attention if they experience:

1. Loss of a loved one
2. Divorce or separation of their parents
3. Any major transition  new home, new school.
4.Traumatic life experiences, like living through a natural
disaster
5.Teasing or bullying
6. Difficulties in school or with classmates

1. Communicate in a straightforward
manner
2. Communicate at a level that is appropriate to a child's
age and development level
3. Have the discussion when the child feels safe and
comfortable
4. Watch their child's reaction during the discussion
5. Slow down or back up if the child becomes confused or
looks upset
6. Listen openly and let your child tell you about his or
her feelings and worries

Considering these points will help any
child be more relaxed and understand more of the
conversation.

Do you need help starting a
conversation with your child about mental health? Try
leading with these questions. Make sure you actively listen
to your childs response.

1. Can you tell me more about what is
happening? How you are feeling.
2. Have you had feelings like this in the past?
3. Sometimes you need to talk to an adult about your
feelings. Im here to listen. How can I help you feel
better?
4. Do you feel like you want to talk to someone else about
your feelings?
5. Im worried about your safety. Can you tell me if
you have thoughts about harming yourself or
others?

Seek immediate assistance if you think
your child is in danger of harming themselves or others. You
can call a crisis line or the National Suicide Prevention
Line at 1.800.273.TALK (8255).

If your child is in need of community
mental health services, check out your local school health
center.

Pre-School Age
Children

Young children need less information
and fewer details because of their more limited ability to
understand. Preschool children focus primarily on things
they can see, for example, they may have questions about a
person who has an unusual physical appearance, or is
behaving strangely. They would also be very aware of people
who are crying and obviously sad, or yelling and
angry.

School-Age Children

Older children may want more
specifics. They may ask more questions, especially about
friends or family with emotional or behavioral problems.
Their concerns and questions are usually very
straightforward. "Why is that person crying? Why does Daddy
drink and get so mad? Why is that person talking to
herself?" They may worry about their safety or the safety of
their family and friends. It is important to answer their
questions directly and honestly and to reassure them about
their concerns and feelings.

Teenagers

Teenagers are generally capable of
handling much more information and asking more specific and
difficult questions. Teenagers often talk more openly with
their friends and peers than with their parents. As a
result, some teens may have already have misinformation
about mental illnesses. Teenagers respond more positively to
an open dialogue which includes give and take. They are not
as open or responsive when a conversation feels one-sided or
like a lecture.

Talking to children about mental
illnesses can be an opportunity for parents to provide their
children with information, support, and guidance. Learning
about mental illnesses can lead to improved recognition,
earlier treatment, greater understanding and compassion, as
well as decreased stigma. 800/969-6642 www.nmha.org

How
to Talk About Mental Health
Do you need help starting a conversation with your child
about mental health? Try leading with these questions. Make
sure you actively listen to your childs
response.

Can you tell me more about what is
happening? How you are feeling?

Have you had feelings like this in
the past?

Sometimes you need to talk to an
adult about your feelings. Im here to listen. How
can I help you feel better?

Do you feel like you want to talk
to someone else about your problem?

Im worried about your
safety. Can you tell me if you have thoughts about
harming yourself or others?

When talking about mental health
problems with your child you should:

Communicate in a straightforward
manner

Speak at a level that is
appropriate to a child or adolescents age and
development level (preschool children need fewer details
than teenagers)

Discuss the topic when your child
feels safe and comfortable

Watch for reactions during the
discussion and slow down or back up if your child becomes
confused or looks upset

Listen openly and let your child
tell you about his or her feelings and
worries

Related Video

Glenn Close talks about her family's
experience with mental health problems, and the importance
of talking and learning about mental health issues. "I
challenge every American family to no longer whisper about
mental illness behind closed doors," she said.

Learn More about Supporting Your
Children

There are many resources for parents
and caregivers who want to know more about childrens
mental health. Learn more about:

Recognizing mental health problems
in children exit disclaimer icon, how they are affected,
and what you can do

Talking to children and youth
after a disaster or traumatic event exit disclaimer icon
(PDF  796 KB)

Get Help for Your
Child

Seek immediate assistance if you think
your child is in danger of harming themselves or others. You
can call a crisis line or the National Suicide Prevention
Line at 1.800.273.TALK (8255).

If your child is in need of community
mental health services, find help in your area and possibly
from your school health center.

Mental
health of children and young people at risk in digital
age
Cyberbullying and rise in self-harm highlighted by MPs
voicing concern over violent video games and
sexting

Violent video games, the sharing of
indecent images on mobile phones, and other types of digital
communications, are harming young peoples mental
health, MPs warned on Wednesday, amid evidence of big
increases in self-harm and serious psychological problems
among the under-18s.

Cyberbullying
and websites advocating anorexia and self-harm are also
posing a danger to the mental wellbeing of children and
young people, the Commons health select committee says in
its report.

Sarah Wollaston, chair of the
committee, who was a GP for 24 years before becoming a Tory
MP in 2010, said: In the past if you were being
bullied it might just be in the classroom. Now it follows
[you] way beyond the walk home from school. It is
there all the time. Voluntary bodies have not suggested
stopping young people using the internet. But for some young
people its clearly a new source of
stress.

However, the MPs said they had found
no evidence that the emerging digital culture was behind the
worrying rise, of up to 25% to 30% a year, in numbers of
children and young people seeking treatment for mental
health problems.

The cross-party group acknowledges
that forms of online and social communication are now
central to the lives of under-18s, but says that a
government inquiry into the effects is needed because of the
potential for harm.

For todays children and
young people, digital culture and social media are an
integral part of life this has the potential to
significantly increase stress and to amplify the effects of
bullying, the committees report says.

Some young people experience
bullying, harassment and threats of violence
when online, the MPs say. While they did not look into
internet regulation in depth during their six-month inquiry,
they concluded: In our view sufficient concern has
been raised to warrant a more detailed consideration of the
impact of the internet on childrens and young
peoples mental health, and in particular the use of
social media and impact of pro-anorexia, self-harm and other
inappropriate websites.

It calls on the Department of Health
and NHS Englands joint taskforce, now investigating,
alongside bodies such as the UK Council for Child
Internet
Safety, the mental health of under-18s, to assess the impact
of social media.

The MPs appreciate the move for
e-safety to be taught at all four education key-stages in
England. But they also want the Department for Education, as
part of a review of mental health education in schools, to
ensure that links between online safety,
cyberbullying, and maintaining and protecting emotional
wellbeing and mental health are fully
articulated.

Wollaston voiced concern that
sexting (sharing indecent photographs) could be
traumatic for vulnerable young women persuaded to pose for
intimate pictures then finding the shots shared widely. Some
would end up being harassed, she said. Sexting had
become normalised in some school environments,
she said. We need much better education about the
dangers of sexting. She also expressed unease about
the impact of violent video games played by young people.
Parents, she said, should do more to check what their
offspring were doing online in their free time and talk to
them because if they are spending two hours a night
doing that, is that harming their child?

Lucie Russell, director of campaigns
and media at the charity Young Minds, said: The 24/7
online world has the potential to massively increase young
peoples stress levels and multiplies the opportunities
for them to connect with others in similar distress.
Websites like Tumblr, where there has been recent media
focus on self-harm blogs, must do all they can to limit
triggering content and that which encourages self-harming
behaviour.

Russell backed the committees
view that the internet could also be a valuable source
of support for children and young people with mental health
problems. But, she added that many professionals
feel completely out of touch with, even intimidated by,
social media and the net.

The report paints a grim picture of
the growing number of under-18s needing care, often
struggling to access it, or becoming an inpatient hundreds
of miles from home, as childrens and adolescents
mental health services tried to cope with budget cuts, lack
of staff and too few beds.

Major problems in
accessing services ends with children and young
peoples safety being compromised while they wait for a
bed to become available, say the MPs.

Services are under such pressure that
in some parts of England children only get seen by a
psychiatrist if they have already tried to take their own
lives at least once.

Despite growing need, criteria for
being referred for NHS treatment have been tightened in most
of England, the MPs say.

Liz Myers, a consultant psychiatrist
with the Cornwall Partnership NHS foundation trust, told the
inquiry that its services for the young were receiving 4,000
referrals a year, though were only commissioned by the NHS
to do 2,000.

This has meant that we are
necessarily having to prioritise those who have the most
urgent and pressing need, and we have no capacity for
earlier intervention and very little capacity for seeing
those perhaps with the less life-threatening or urgent risky
presentations.

There are increasing waits. It
is not okay. We do not want that for our children and young
people, but we have to just keep
prioritising.

Men and Mental
HealthDr. Sara Hickmann is a Clinical Counselor for the
Fleet and Family Support Center at Naval Base Point Loma in
San Diego, CA. Previously, she served as the Director of
Player Assistance Services in the Player Development
Department at the National Football League (NFL) from 2004
to 2009. We asked Dr. Hickmann to compile a list of commonly
held misconceptions about mens mental
health.

Our goal in the Mens Mental
Health Campaign is to challenge some of the common yet false
beliefs that men hold about mental health, particularly the
beliefs that might prevent them from getting the help they
need. Lets start the conversation.

Common Belief: I
dont need help. I got this.

Research shows that, often, the men
who need mental health services most  stressed out,
successful, athletic, family men  are also the least
interested in getting help. The traditional male role
encourages a preoccupation with success, power and
competition. And yet these types of men are at higher risk
of negative psychological consequences, such as depression,
anxiety, and relationship problems.

Common Belief: Talking
about my problems is not going to change
anything.

The term normative male
alexithymia has been used to describe mens
problems with expressing their emotions, a possible
contributor to depression and barrier to treatment. Men are
geared towards problem solving, but sometimes holding in how
you feel is part of the problem. When you start talking
about things that bother you or are causing stress, the
problem solving can begin. Athletes will huddle
up on the court or field to make a plan or a game
strategy and make adjustments as they go along. This is
similar to what happens in counseling or therapy.

Common Belief: Its
not that bad, its the way Ive always
been.

Most likely, you dont like to go
to the doctor when you have a fever, sore throat, and cough.
You probably want to ride it out and see if you can just get
better on your own. But then you realize the cough has now
turned into bronchitis and you arent able to work.
Mental health issues can be similar. It can be hard to know
when its time. Sometimes, you just need to talk. And,
other times, its pretty bad. You cant get out of
bed or function. Untreated depression and other psychiatric
problems can result in personal, family, and financial
problems, even suicide. According to NIMH, four times as
many men as women die by suicide in the United States, which
may result from a higher prevalence of untreated depression.
Yet eight out of 10 cases of depression respond to
treatment.

Common Belief: People
will think I am crazy if I see a
psychologist.

Our brains are sensitive organs that
respond to our genetics, traumatic life events, and stress.
Many of these factors are not in our direct control. Men may
express their depression in terms of increases in fatigue,
irritability and anger, loss of interest in work, and sleep
disturbances. It has also been shown that men use more drugs
and alcohol, perhaps to self-medicate. This can mask the
signs of depression, making it harder to detect and treat
effectively. A diagnosis is not a life sentence. A diagnosis
can be a name of a condition that provides a road-map for
proper treatment and improvement in your mood,
relationships, and life.

Start the conversation. With someone
you trust. With someone who is trained. With someone who
cares. Ask questions. Start the conversation.

Conversation Guide

Some tips to start a conversation with
someone about concerns around mental health.

DO: OBSERVE, COMMUNICATE, RESPECT

DONT: ASSUME, ALIENATE,
LABEL

Start a Conversation

Educate yourself before
approaching the topic of mental health.

Find a place thats both
comfortable and private.

Dont just talk about mental
health  talk about other things you normally
discuss or an activity/hobby you share.

Pick a time when you can both chat
without interruption or distraction.

Be relaxed, open and approachable
in your body language.

Validate their
feelings.

Ask open-ended questions:
How are you? or Whats been going
on?

Listen Without
Judgment

Whatever they are saying, take it
seriously.

Do not interrupt.

Encourage them to explain what
they are struggling with.

Avoid using stigmatizing words and
language.

Ask How does it make you
feel? or How long have you felt that
way?

Encourage Action

Show that youve listened by
recapping.

Help them think about options and
next steps.

Urge them to commit to doing one
thing that might help.

Ask them to write their feelings
down if that is more comfortable than
speaking.

If necessary, encourage them to
see a doctor or health professional.

Offer to go with them to see a
doctor or health professional.

Follow Up

Put a note on your calendar to
call them in one week. If theyre really struggling,
follow up sooner.

Make sure theyve managed to
take that first step and see someone.

If they didnt find this
experience helpful, urge them to try a different
professional because theres someone out there who
can help them.

Schedule regular get-togethers to
touch base or just spend time together doing fun
activities.

Some helpful comments: How
are things going? Did you speak with your doctor? ?What
did they suggest? What did you think of their advice??
Youve had a busy time. Would you like me to make
the appointment?

Dealing with Denial?

If they deny the problem,
dont criticize. Acknowledge theyre not ready
to talk.

Say youre still concerned
about changes in their behavior and you care about
them.

Ask if you can check in again next
week if theres no improvement.

Avoid a confrontation with the
person unless its necessary to prevent them hurting
themselves or others.

Some helpful comments:
Its ok that you dont want to talk about
it but please dont hesitate to call me when
youre ready to discuss it. Can we meet up next week
for a chat? Is there someone else youd rather
discuss this with?

Is Their Life in
Danger?

If someone says theyre
thinking about suicide, its important you take it
seriously.

Tell them that you care about them
and you want to help. Dont become agitated, angry
or upset.

Explain that thoughts of suicide
are common and dont have to be acted
upon.

Ask if theyve begun to take
steps to end their life. If they have, its critical
that you do NOT leave them alone and do NOT use guilt or
threats to prevent suicide.

Even if someone says they
havent made a plan for suicide, you still need to
take it seriously.

Dont hide suicidal comments
even if asked to keep confidential  reach out for
help.

Get immediate crisis help by calling
1-800-273-TALK (8255) or Texting "SOS" to
741741..

For
Parents and Caregivers
As a parent or caregiver, you want the best for your
children or other dependents. You may be concerned or have
questions about certain behaviors they exhibit and how to
ensure they get help.

What to Look For

It is important to be aware of warning
signs that your child may be struggling. You can play a
critical role in knowing when your child may need
help.

Consult with a school counselor,
school nurse, mental health provider, or another health care
professional if your child shows one or more of the
following behaviors:

Feeling very sad or withdrawn for
more than two weeks

Seriously trying to harm or kill
himself or herself, or making plans to do so

Experiencing sudden overwhelming
fear for no reason, sometimes with a racing heart or fast
breathing

Getting in many fights or wanting
to hurt others

Showing severe out-of-control
behavior that can hurt oneself or others

Not eating, throwing up, or using
laxatives to make himself or herself lose
weight

Having intense worries or fears
that get in the way of daily activities

Experiencing extreme difficulty
controlling behavior, putting himself or herself in
physical danger or causing problems in school

Using drugs or alcohol
repeatedly

Having severe mood swings that
cause problems in relationships

Showing drastic changes in
behavior or personality

Because children often cant
understand difficult situations on their own, you should pay
particular attention if they experience:

Loss of a loved one

Divorce or separation of their
parents

Any major transition  new
home, new school, etc.

Traumatic life experiences, like
living through a natural disaster

Teasing or bullying

Difficulties in school or with
classmates

2:01Former Senator Gordon
Smith

Sen. Gordon Smith shares his story
about mental health problems, and encourages others to
"bring mental health issues out of the shadows."

What to Do

If you are concerned your childs
behaviors, it is important to get appropriate care. You
should:

Talk to your child's doctor,
school nurse, or another health care provider and seek
further information about the behaviors or symptoms that
worry you

Ask if your childs
specialist is experienced in treating the problems you
are observing

Talk to your medical provider
about any medication and treatment plans

Talking with Kids
about Mental Health
Mental health is a state of psychological well-being in
which a child can cope effectively with normal stresses, be
productive and contribute to her or his
community.

Data Highlights

Childrens mental health problems
are an important public health issue because of their
prevalence, early onset and detrimental impacts on kids,
families and communities. Half of all mental health
disorders start by age 14 and, in any given year, up to 20%
of US children have mental health problems. This translates
to approximately 1.8 million California children that suffer
from mental health problems each year. Left untreated,
children with mental health problems are at greater risk of
abusing drugs or alcohol, becoming involved with the
criminal justice system, dropping out of school and
committing suicide.

Significant adversity experienced in
early childhood, such as stress associated with persistent
poverty or chronic neglect, can severely impact brain
development and lead to decreased mental and physical
well-being throughout a childs lifetime. Even very
young children can suffer from serious mental health
disorders: over 10% of children, ages 2-5, are diagnosed
with a mental health disorder. Parental well-being also
directly impacts early childhood mental health, which is of
particular importance given that postpartum depression
affects 1 in 7 women.

Annually, approximately 37% of
California children who need mental health treatment or
counseling do not receive services. Young children and those
in poverty are even less likely to receive needed services.
Despite the fact that early intervention is effective, 60%
of California children under age 6 who needed mental health
services did not receive them.

Pro-Kid Policy
Agenda

To fight the growing, costly and
potentially tragic epidemic of poor mental health among
children, the state should promote childrens access to
mental health care by requiring the health plans that it
contracts with to make improvements in mental health service
delivery and follow-up, including coordination with primary
care networks and providers. California should also work
expeditiously with counties to effectively leverage all
funds generated by the Mental Health Services Act of 2004,
and emphasize early intervention programs.

Momentum

Mental health programs in California
have been drastically cut recently; the states
spending on mental health was reduced by 21% between 2009
and 2012. Federal health care reform makes mental health
services an essential benefit in childrens
health coverage, which means that childrens access to
mental health coverage and care will be substantially
increased beginning in 2014.

Californias Early Mental Health
Initiative has helped tens of thousands of young children
who suffer from mild to moderate mental health challenges
through proven school-based prevention and early
intervention programs; however, funding for the program was
eliminated in the 2012-13 budget and has not been restored
since, despite over 20 years of successful implementation
and its modest cost of $15 million per year.Source: www.childrennow.org/index.php/learn/mental_health/

College
Over the last few months, I have had the privilege of
writing about the Each Mind Matters Movement and trying to
help take away some of the stigma that goes along with
mental illness issues. The Each Mind Matters Movement is
doing a great job of bringing prevention and early
intervention to those in need, providing local programs
& making sure that underserved audiences are a priority,
because no matter what race you are, how much money you make
or where you live, everyone can benefit from improved mental
health!

So often in the news, we hear about
kids committing or attempting suicide for a variety of
reasons. The ages of these kids keeps getting younger &
younger, it seems. As adults, we not only need to be honest
with kids about our own mental health struggles, but also to
let our kids know that getting help for themselves is also
OK and no matter what they have questions about in regards
to their mental health, asking those questions and seeking
help is ALWAYS better than not saying anything.

Talking to kids about this kind of
stuff isnt always easy though. Every child is going to
respond to different things & different approaches. A
few years back, I heard a speaker at a conference for the
charter school my kids were going to attend. I wish I could
remember his name because I really like what he had to say.
He was talking about the differences in boys and girls and
how if you were to take a look at high school during lunch
time, a lot of the times, you would see a group of girls all
huddled together talking. But, a group of boys would usually
be standing side by side, sometimes leaning against a wall
but usually not looking at each other eye to eye. He said
that that is how he talks to his kids and Ive started
doing that too. When I need to talk to my son, who is 15, I
find it best to do so as were driving somewhere in the
van. This way, were side by side and he seems to
respond better. With my daughter (who is 11), I find that
its better to go somewhere, away from the house, where
we can sit and talk to each other face-to-face, without any
disruptions. Again, every child is different but that is
what works for us.

Also, if there is a certain subject I
need to talk to my kids about & its a sensitive
matter, I try to collect my thoughts and wait a little bit
until I have thought it out. Trust me when I say I am FAR
from perfect when it comes to this but Ive noticed
that when I have calmed down or have my thoughts all
together, my kids react better too.

In the past when I have gone to
therapy or been on medication for depression & anxiety,
I dont hide it from my kids. Obviously, I wont
tell them everything I talk about in counseling but I
dont let depression & anxiety stay a family
secret. When I am anxious about something, say an important
doctor appointment, Ive let them know that I am
anxious and why. They can sense it, theyre smart
kids telling them everything is fine or not
letting them know anything, is pretty much telling them to
lie & not be honest about their own mental
health.

We can end the stigma of mental health
issues, not only for ourselves but for our kids as well. If
you head on over to the Each Mind Matters website, you can
find an area to pledge to join the movement.

 Ending the stigma associated
with mental illness is a personal choice. We have to decide
for ourselves that each mind really does matter. Each one of
us must determine what we will do to make a difference.

Helping
their college-age kids cope with the high stress of
undergraduate life
For all those freshman just settling into dorm life this
fall, college can be exhilarating, mind-blowing, the best
years of their lives. But many parents dont realize
that their children are also facing a potential double
whammy. Not only must new students navigate an entirely
unfamiliar social, emotional and intellectual landscape, but
theyre also entering a time in their lives  the
ages between 18 and 21  when many mental illnesses,
from anxiety to depression to eating disorders,
peak.

This week, The Checkup, our podcast on
Slate, explores the mental health of college students.
Heres one sobering statistic: up to 50% of college-age
kids have had or will have some kind of psychiatric
disorder. Thats why were calling this episode
Meltdown U. (To listen to The Checkup now, click
on the arrow above; to download and listen later, press
Download; and to get it through iTunes click
here.)

Consider some more scary
numbers:

80% of college students who need
mental health services wont seek them

50% of all college students say
they have felt so depressed that they found it difficult
to function during the last school year

Suicide is the second leading
cause of death among college-age youth  over 1000
deaths per year.

The rate of student psychiatric
hospitalizations has tripled in the past 20
years.

We asked Dr. Eugene Beresin, M.D., a
child psychiatrist at Massachusetts General Hospital and
professor of psychiatry at Harvard Medical School, to offer
some guidance on what parents should know about helping
their college-age kids cope with the high stress of
undergraduate life. Heres his advice:

1. Be Prepared

It is likely your kid will experience
a mental health problem or encounter one in a roommate or
classmate. Discuss this, and talk about what to do if it
happens. You might say, Talk with some adult to get
advice. This could be me, a dorm advisor, or mental health
counselor. Dont think things will just pass. They
could get worse.

Inform your kids about the mental
health realities.

2. Get Information About Mental
Health and Illness

Some colleges have great websites on
mental health services. They just dont promote this
nor do many educate parents or students about the signs and
symptoms of psychiatric problems. Some colleges may have
information online, or you can go to other sites for trusted
resources about college student mental health, even other
college sites (good examples include Cornell, MIT,
University of Pittsburgh). For educational material about
the disorders themselves go to your state psychiatric
association website (branches of the American Psychiatric
Association or the American Academy of Child and Adolescent
Psychiatry).

3. Learn about College Mental
Health Services

Though no one will direct you, call
the counseling center and ask about the kind of coverage,
professional staff and the range of services for your kid.
And talk with the highest staff member you can. The person
answering the phone may know little or nothing about what
really is available. It may be a student volunteer, or an
administrator who does not know the answers you
seek.

4. Find Out About Your Insurance
Coverage

This can be really hard. Think about
your own coverage! The mental health system is very
complicated. Call and ask about the number of office visits
per year. Ask how many are just for medications, and how
many are for therapy. Many insurance companies will say
we have unlimited visits for biological
conditions. But this means, unlimited 15 minute
visits for medication management. If the coverage is
obtained through the college, ask if it also covers visits
off campus.

5. Learn About Local Mental Health
Services Off Campus

Many college mental health services
will be limited so its important to see what may be
available off campus at a local counseling center or
hospital. If you need help in finding out which is really
good, call a nearby medical school with an associated
Department of Psychiatry, and ask what facilities are
recommended. If there is not a Department of Psychiatry,
call the nearest teaching hospital for a medical school in
the state, even if its not right near your college.
Another good resource is the local chapters of the National
Alliance on Mental Illness (NAMI).

6. Dont Worry About
Stigma

Of course there is stigma associated
with psychiatric illness. Our culture will not change
overnight. One in four people will have a psychiatric
disorder during the course of life. Worrying that this will
be a black mark on your childs record is natural but
there should be even greater worry if mental illness goes
untreated. Many individuals who are highly successful have
had psychiatric treatment and this does not interfere with
success in their career or in relationships. Quite the
contrary. Help may prove invaluable for functioning in
life.

7. Talk With Your Kids About Mental
Health and Illness

It is one thing for us as parents to
get the best information about psychiatric problems,
relationship and drug issues. But your kids need this
information too. They are living with this; they see their
friends in trouble. Involve them in all of the tips
described here. You will be surprised how much they want to
know, what they have seen and their receptivity. Engage
them. Let them know theyre not alone. Opening this
door will serve them well, and is more likely to help them
feel comfortable to talk about themselves and their
experiences without feeling judged.

8. Get Help Early

The earlier your kid gets services for
any emotional, behavioral or learning problem the better.
While mental illness is misunderstood and the system is very
difficult to navigate even for the best educated (even by
doctors), most psychiatric disorders can be successfully
treated. The key is early intervention and prevention of
complications.

9. Be Brave

Colleges do their best, but are sorely
lacking in resources, and frankly wary of putting such
stigmatized problems on the front burner. You have to teach
your child that its okay to ask for help and advocate
for his or her own mental health needs.

10. Sleeping and Eating For Body
& Mind

This may seem banal and irrelevant but
getting enough sleep and not living on ramen goes a long way
in retaining sanity. Remind your kid that pulling frequent
all-nighters to study may be harmful to their long-term well
being. Getting into a daily exercise routine can also
alleviate stress in a profound way.

Readers, any specific questions
lingering in your minds? Please post questions below, or
tweet Dr. Beresin at @GeneBeresinMD. You can see his sources
for this post here, here, here and here.

Help Bring
Good Samaritan Laws to Your StateAccidental drug overdoses are now the leading cause of
accidental death in the United States. Some of these deaths
could be prevented if the patient received medical care in a
timely manner. The Partnership for Drug-Free Kids supports
policies like Good Samaritan laws which encourage people to
call 911 when someone is overdosing. Currently 35 states and
the District of Colombia have such laws. We encourage every
state to enact legislation which provides limited legal
immunity for minor drug law violations for those who call
for help as well as the person who is overdosing.

There are currently 35 states plus DC
with Good Samaritan Overdose Laws. If your state has not yet
adopted this life saving policy (see list below), you can
send the following suggested letter to your Governor urging
the state to do so.

Arizona

Idaho

Indiana

Iowa

Kansas

Maine

Missouri

Montana

Nebraska

Ohio

Oklahoma

South Carolina

South Dakota

Texas

Wyoming

Wisconsin

Suggested Letter

Dear Governor Kate Brown:

Accidental drug overdoses are now the
leading cause of accidental death in the United States. Some
of these deaths could be prevented if the patient received
medical care in a timely manner. Good Samaritan laws, which
encourage people to call 911 when someone is overdosing,
help to ensure that there is not an unnecessary delay in
getting medical attention for the patient. Currently 35
states and the District of Colombia have such laws. I
encourage you to fight for this law in our state to provide
limited legal immunity for minor drug law violations for
those who call for help as well as the person who is
overdosing. Good Samaritan laws will save lives and prevent
countless families from the heartache of losing a loved
one.Source: drugfree.org/help-bring-good-samaritan-laws-to-your-state/

Mental Health
Parity and Addiction Equity ActThe Mental Health Parity and Addiction Equity Act
(MHPAEA) was passed in 2008 but has yet to be readily
implemented and enforced. The Department of Health and Human
Services (HHS) and the Department of Labor (DOL) have not
provided consistent guidelines on how to enforce this
legislation. Download
this useful guide
(a 103 page PDF) to better understand the legislation, and
how you can more successfully appeal your health plan to
provide needed coverage.

The lack of enforcement has left too
many families with inadequate health coverage for their
childs substance abuse treatment. We think this is
unacceptable and are calling for the HHS and DOL agencies to
sufficiently implement this law.

Please write your Congressman and urge
them to sign on to the below letter demanding action to
enforce MHPAEA.

* * *

Dear Colleague,

We all know the statistics that are
staggering. Over 41,000 Americans died from suicide in 2013
and suicide is the third leading cause of death for 15-24
year olds. 120 Americans a day are dying from drug
overdoses, and overdose now exceeds vehicular accidents as a
leading cause of death. Sadly, only 10 percent of
individuals diagnosed with a substance use disorder receive
any help for their illness and only 20 percent of children
with a mental illness diagnosis receive care. Our system is
broken.

The Mental Health Parity and Addiction
Equity Act (MHPAEA) was passed with overwhelming bipartisan
majorities in the House and Senate and signed into law in
2008 by President George W. Bush. Seven years have elapsed
and final regulations are still not fully implemented.
Unfortunately, the Departments of Health and Human Services
and Labor have provided only limited guidance on how states
must comply with MHPAEA and enforcement has been
inconsistent.

Not fully using MHPAEA to combat the
twin public health crises of untreated mental illness and
substance use disorders has led to a lack of access to care
and the nearly 50,000 Americans annually who lose their
lives because of untreated mental illness and addiction.
These are needless tragedies that are creating devastating
effects on individuals, families and communities.

In April 2015, a National Alliance on
Mental Illness report showed that consumers are unable to
access provider lists before buying a health plan and are
unable to access information they need to make informed
decisions about which plan best serves their
needs.

As a result, we are circulating a
letter to Department of Health and Human Services Secretary
Sylvia Burwell and Department of Labor Secretary Thomas
Perez asking them to take immediate action to implement and
enforce the Mental Health Parity and Addiction Equity
Act.

Specifically, our letter urges HHS and
DOL to report back to Congress on the following:

1. How many audits has your Department
conducted to determine compliance with MHPAEA? What were the
results of those audits? Will de-identified results of the
audits be made available on your website? If audits have not
been conducted, will your agencies be conducting them in the
future?

2. Does your Department plan to issue
additional parity guidance to health plans and issuers on
what documents and analyses they must conduct and disclose
in order to demonstrate compliance with MHPAEA? If so, by
what date?

3. When will Medicaid parity final
regulations be released? When will enforcement for parity
under Medicaid and the Childrens Health Insurance
Program begin?

Thank you for your attention to this
important issue.

Sincerely,

Tim Murphy
Member of Congress

Paul Tonko
Member of Congress

The stigma that
goes along with mental illness issuesOver the last few months, I have had the privilege of
writing about the Each Mind Matters Movement and trying to
help take away some of the stigma that goes along with
mental illness issues. The Each Mind Matters Movement is
doing a great job of bringing prevention and early
intervention to those in need, providing local programs
& making sure that underserved audiences are a priority,
because no matter what race you are, how much money you make
or where you live, everyone can benefit from improved mental
health!

So often in the news, we hear about
kids committing or attempting suicide for a variety of
reasons. The ages of these kids keeps getting younger &
younger, it seems. As adults, we not only need to be honest
with kids about our own mental health struggles, but also to
let our kids know that getting help for themselves is also
OK and no matter what they have questions about in regards
to their mental health, asking those questions and seeking
help is ALWAYS better than not saying anything.

Talking to kids about this kind of
stuff isnt always easy though. Every child is going to
respond to different things & different approaches. A
few years back, I heard a speaker at a conference for the
charter school my kids were going to attend. I wish I could
remember his name because I really like what he had to say.
He was talking about the differences in boys and girls and
how if you were to take a look at high school during lunch
time, a lot of the times, you would see a group of girls all
huddled together talking. But, a group of boys would usually
be standing side by side, sometimes leaning against a wall
but usually not looking at each other eye to eye. He said
that that is how he talks to his kids and Ive started
doing that too. When I need to talk to my son, who is 15, I
find it best to do so as were driving somewhere in the
van. This way, were side by side and he seems to
respond better. With my daughter (who is 11), I find that
its better to go somewhere, away from the house, where
we can sit and talk to each other face-to-face, without any
disruptions. Again, every child is different but that is
what works for us.

Also, if there is a certain subject I
need to talk to my kids about & its a sensitive
matter, I try to collect my thoughts and wait a little bit
until I have thought it out. Trust me when I say I am FAR
from perfect when it comes to this but Ive noticed
that when I have calmed down or have my thoughts all
together, my kids react better too.

In the past when I have gone to
therapy or been on medication for depression & anxiety,
I dont hide it from my kids. Obviously, I wont
tell them everything I talk about in counseling but I
dont let depression & anxiety stay a family
secret. When I am anxious about something, say an important
doctor appointment, Ive let them know that I am
anxious and why. They can sense it, theyre smart
kids telling them everything is fine or not
letting them know anything, is pretty much telling them to
lie & not be honest about their own mental
health.

We can end the stigma of mental health
issues, not only for ourselves but for our kids as well. If
you head on over to the Each Mind Matters website, you can
find an area to pledge to join the movement.

 Ending the stigma associated
with mental illness is a personal choice. We have to decide
for ourselves that each mind really does matter. Each one of
us must determine what we will do to make a difference.

No proof that 85% of
mental health apps accredited by the NHS actually work
Depression Apps: in theory

Its an inconvenient reality that
while demand for psychological services seems to be forever
increasing, NHS resources designated for the treatment of
mental health problems are going the other way. The
unfortunate, but inevitable result is that unmet need for
NHS mental health services has reached an unprecedented
level (Cooper, 2014).

To illustrate the situation, monthly
referrals to community mental health teams increased over
13% in 2013, and 16% in the case of crisis services (The
Mental Health Policy Group, 2015), yet roughly 200 full-time
NHS mental health doctors, and 3,600 nurses were lost over
the same period (Cooper, 2014).

This has meant that despite the
new NHS standard whereby 95% of those with a
mental health issue are to be seen within 18 weeks (NHS
England, 2015), 1 in 10 are waiting over a year before
receiving any form of treatment, with 1 in 2 waiting over 3
months (We Need To Talk Coalition, 2013).

While this is a problem in itself, a
seemingly much bigger problem is the reality that 1 in 6 of
those on waiting lists for mental-health services are
expected to attempt suicide, 4 in 10 are expected to
self-harm and 6 in 10 will likely to see their condition
deteriorate before having the opportunity to see a mental
health professional (Cooper, 2014).

So how should the NHS and its patients
respond? With the widespread availability and increased
reliance upon smart phones, one increasingly popular
suggestion is the use of apps. Our own experiences can tell
us that apps are relatively inexpensive and widely
available, but probably most importantly, the use of an app
by one person wont prevent another using the same
service at the same time. Given the history of long waiting
lists for mental health services this is a highly desirable
trait for future NHS services, which could result in
flexible, user-led healthcare delivery.

MIND have reported that just 50% and
13% of people currently have a choice as to when and where
they receive therapy respectively (We Need To Talk
Coalition, 2011), and as such, its also possible that
the wider-spread use of apps could extend the reach of
traditional mental-health services to those who, for one
reason or another, are not currently able to engage with
treatment. Examples may include the teenager who is too
anxious or stigmatised to discuss his condition
face-to-face, the armed forces serviceman for whom a desire
for anonymity is paramount (Murphy & Busuttil, 2014), or
the single-mother who struggles to schedule an appointment
around her childcare and work commitments.

With 1 in 10 people with a
mental health problem waiting over a year for treatment,
perhaps apps can help cut the queues?

Depression Apps: in
practice

Regrettably, the reality is that
theres currently a considerable gap between the
benefits that apps may provide in theory, and what they are
likely to deliver in practice.

Taking a look at the NHS Apps Library,
there are currently 27 mental health apps accredited for use
by patients, with a total of 14 designated for the
treatment/management of the symptoms of depression and
anxiety. Upon close inspection, terms such as control
stress, increase wellbeing, beat
depression and improve mood are frequently
listed benefits from downloading, and often purchasing these
apps.

Worryingly though, just 4/14 are able
to provide any tangible evidence of outcomes, as reported by
real-world users, to substantiate their claims, while just
2/14 make use of NHS-validated performance measures
including the Generalised Anxiety Disorder 7 (GAD-7)
questionnaire, which is routinely used to assess the
effectiveness of other NHS-accredited treatments, including
counselling and cognitive-behavioural therapy.

As a result, we are currently facing
an open question regarding the true-effectiveness of the
remaining 85% (12/14) of NHS-accredited mental health
apps.

The majority of depression
and anxiety apps accredited by the NHS Apps Library have
no tangible evidence of outcomes to substantiate their
claims.

Room for concern?

In 2013, a review of mHealth apps
found that from 2003-2013 just 32 articles were published
regarding depression apps, compared with a total of 1,536
available for download (Martínez-Pérez et al,
2013). While this finding of a high availability, but low
underlying evidence-base is concerning, it could arguably be
expected from the open and largely unregulated free-markets
that are the app stores. In contrast, the apps under
consideration here are the beneficiaries of a seal of
approval from a world-leading healthcare system, and
as a result, the expectation is that they are of
significantly greater quality.

This is a worrying situation. Most of
us would acknowledge that there is a perceived implicit
level of quality that comes with accreditation or
association with the NHS, with reputation and legitimacy of
sources known to be highly correlated with app downloads
(Dennison et al, 2013). Considering that 3 in 10 individuals
with an untreated mental health issue currently opt to pay
for treatments privately (We Need To Talk Coalition, 2011),
the recommendation of, purchase and use of apps that are yet
to demonstrate any objectively measurable benefits to users,
is not only a potential waste of money, but could also
potentially have a compounding and devastating effect on
levels of anxiety in those with the greatest need and the
least access to effective NHS-led mental health
services.

The NHS Apps Library has
closed after just 2 years.

Moving forward

On the large part, the National Health
Service provides a regulatory framework that is second to
none, with the attention to detail, rigour and emphasis on
safety, clinical quality and cost-effectiveness, seeing NICE
tokened as the 4th hurdle to market access.
Unfortunately it would appear that this same level of rigour
has not been applied to the apps that the NHS has, until
now, recommended to patients.

Although the NHS is pushing for a 21st
century approach to healthcare, its important that
this isnt achieved through a dilution of quality, and
fortunately it would appear that the NHS are now taking this
subject more seriously. As of October 16th, the NHS Choices
Health Apps Library will officially cease to exist, with the
National Information Board considering how alternative
models for assessing and regulating health apps may be put
in place, and ultimately how quality control can be
improved.

In the meantime, until such a
framework exists, its imperative that those
considering downloading mental health apps take a moment to
weigh up the available evidence, in order to ensure that
apps dont result in more harm than good. Whilst the
app store is often slim on technical information, and
sifting through medical publications is far from ideal,
there are some clear indications of quality to look out
for:

Firstly, apps supported by a mental
health practitioner are on average more than twice as
effective as those from non-practitioner led developers
(Richards & Richardson, 2012)

Secondly, apps with approval from
other well-established regulatory bodies including the US
Food and Drug Administration (FDA), can act as an
intermediary quality control and help separate those apps
which offer users hope, and those which offer real proven
solutions

Thirdly, are apps forthcoming with the
information they provide? Its easy enough to say
this app beats depression but do they offer any
proof to turn this from what is essentially marketing into
evidence of clinical effectiveness?

Finally, its worth re-enforcing,
that not all mental-health apps are created equally, and
that some, designed with clinical quality and effectiveness
in mind, are providing real solutions and support to their
users. One such app, Big White Wall boasts
recovery rates of 58%, which contrasts with the 44%
exhibited by the NHSs flagship Increasing Access
to Psychological Therapies (IAPT) initiative over the
same period, demonstrating that if done properly, apps
really can improve peoples mental health, at a low
cost and from the comfort of their own home.

What is
Gaslighting?

Youre crazy 
that never happened.

Are you sure? You tend to have a
bad memory.

Its all in your
head.

Does your partner repeatedly say
things like this to you? Do you often start questioning your
own perception of reality, even your own sanity, within your
relationship? If so, your partner may be using what mental
health professionals call
gaslighting.

This term comes from the 1938 stage
play Gas Light, in which a husband attempts to drive his
wife crazy by dimming the lights (which were powered by gas)
in their home, and then he denies that the light changed
when his wife points it out. It is an extremely effective
form of emotional abuse that causes a victim to question
their own feelings, instincts, and sanity, which gives the
abusive partner a lot of power (and we know that abuse is
about power and control). Once an abusive partner has broken
down the victims ability to trust their own
perceptions, the victim is more likely to stay in the
abusive relationship.

There are a variety of gaslighting
techniques that an abusive partner might use:

Withholding: the abusive
partner pretends not to understand or refuses to listen. Ex.
I dont want to hear this again, or
Youre trying to confuse me.

Countering: the abusive partner
questions the victims memory of events, even when the
victim remembers them accurately. Ex. Youre
wrong, you never remember things correctly.

Trivializing: the abusive
partner makes the victims needs or feelings seem
unimportant. Ex. Youre going to get angry over a
little thing like that? or Youre too
sensitive.

Forgetting/Denial: the abusive
partner pretends to have forgotten what actually occurred or
denies things like promises made to the victim. Ex. I
dont know what youre talking about, or
Youre just making stuff up.

Gaslighting typically happens very
gradually in a relationship; in fact, the abusive
partners actions may seem harmless at first. Over
time, however, these abusive patterns continue and a victim
can become confused, anxious, isolated, and depressed, and
they can lose all sense of what is actually happening. Then
they start relying on the abusive partner more and more to
define reality, which creates a very difficult situation to
escape.

In order to overcome this type of
abuse, its important to start recognizing the signs
and eventually learn to trust yourself again. According to
author and psychoanalyst Robin Stern, Ph.D., the signs of
being a victim of gaslighting include:

You constantly second-guess
yourself.

You ask yourself, Am I too
sensitive? multiple times a day.

You often feel confused and even
crazy.

Youre always apologizing to
your partner.

You cant understand why,
with so many apparently good things in your life, you
arent happier.

You frequently make excuses for
your partners behavior to friends and
family.

You find yourself withholding
information from friends and family so you dont
have to explain or make excuses.

You know something is terribly
wrong, but you can never quite express what it is, even
to yourself.

You start lying to avoid the put
downs and reality twists.

You have trouble making simple
decisions.

You have the sense that you used
to be a very different person  more confident, more
fun-loving, more relaxed.

You feel hopeless and
joyless.

You feel as though you cant
do anything right.

You wonder if you are a good
enough partner.

If any of these signs ring true for
you, give us a call at 1-800-799-7233 or chat with us online
from 7 a.m.-2 a.m. CT. Our advocates are here to support and
listen to you. Tags: emotional abuse,Source: www.thehotline.org/2014/05/what-is-gaslighting/

When
the Hospital Fires the BulletMore and more hospital guards across the country carry
weapons. For Alan Pean, seeking help for mental distress,
that resulted in a gunshot to the chest.

When doctors and nurses arrived at
Room 834 just after 11 a.m., a college student admitted to
the hospital hours earlier lay motionless on the floor,
breathing shallowly, a sheet draped over his body. A Houston
police officer with a cut on his head was being helped onto
a stretcher, while another hovered over the
student.

The student, 26-year-old Alan Pean,
had come to the hospital for treatment of possible
bipolar
disorder,
accidentally striking several cars while pulling into the
parking lot. Kept overnight for monitoring of minor
injuries, he never saw a psychiatrist and became
increasingly delusional. He sang and danced naked in his
room, occasionally drifting into the hall. When two nurses
coaxed him into a gown, he refused to have it fastened.
Following protocol, a nurse summoned security, even though
he was not aggressive or threatening.

Soon, from inside the room, there was
shouting, sounds of a scuffle and a loud pop. During an
altercation, two off-duty Houston police officers,
moonlighting as security guards, had shocked Mr. Pean with a
Taser, fired a bullet into his chest, then handcuffed
him.

I thought of the hospital as a
beacon, a safe haven, said Mr. Pean, who survived the
wound just millimeters from his heart last Aug. 27. I
cant quite believe that I ended up
shot.

Like Mr. Pean, patients seeking help
at hospitals across the country have instead been injured or
killed by those guarding the institutions. Medical centers
are not required to report such encounters, so little data
is available and health experts suspect that some cases go
unnoticed. Police blotters, court documents and government
health reports have identified more than a dozen in recent
years.

They have occurred as more and more
American hospitals are arming guards with guns and Tasers,
setting off a fierce debate among health care officials
about whether such steps  along with greater reliance
on law enforcement or military veterans  improve
safety or endanger patients.

The same day Mr. Pean was shot, a
patient with mental
health problems
was shot
by an off-duty police officer
working security at a hospital in Garfield Heights, Ohio.
Last month, a hospital security officer
shot a patientwith bipolar illness in Lynchburg, Va. Two psychiatric
patients died, one in Utah, another in Ohio, after guards
repeatedly shocked them with Tasers. In Pennsylvania and
Indiana, hospitals have been disciplined by government
health officials or opened inquiries after guards used stun
guns against patients, including a woman bound with
restraints in bed.

Hospitals can be dangerous places.
From 2012 to 2014, health care institutions reported a 40
percent increase in violent crime, with more than 10,000
incidents mostly directed at employees, according
to a survey
(17 page PDF) by the International Association for
Healthcare Security and Safety. Assaults linked to gangs,
drug dealing and homelessness spill in from the streets,
domestic disputes involving hospital personnel play out at
work, and disruptive patients lash out. In recent years,
dissatisfied relatives even shot two prominent surgeons in
Baltimore and near Boston.

To protect their corridors, 52 percent
of medical centers reported that their security personnel
carried handguns and 47 percent said they used Tasers,
according to a 2014
national survey
(88 page PDF). That was more than double estimates
from studies
just three years before. Institutions that prohibit them
argue that such weapons  and security guards not
adequately trained to work in medical settings  add a
dangerous element in an already tense environment. They say
many other steps can be taken to address problems,
particularly with people who have a mental
illness.

Massachusetts General Hospital in
Boston, for example, sends some of its security officers
through the state police academy, but the strongest weapon
they carry is pepper spray, which has been used only 11
times in 10 years. In New York Citys public hospital
system, which runs several of the 20 busiest emergency rooms
in the country, security personnel carry nothing more than
plastic wrist restraints. (Like many other hospitals, the
system coordinates with the local police for crises its
staff cannot handle.)

Tasers and guns send a
bad message in a health care facility, said Antonio
D. Martin, the systems executive vice president for
security. I have some concerns about even having
uniforms because I think that could agitate some
patients.

But many hospitals say that with
proper safeguards  some restrict armed officers to
high-risk areas like emergency rooms and parking areas
 and supervision, weapons save lives and defuse
threatening situations. The Cleveland Clinic, which has
placed metal detectors in its emergency room, has its own
fully armed police force and hires off-duty officers as
well. The University of California medical centers at Irvine
and San Diego and small community hospitals are among the
more than 200 facilities that use stun guns produced by
Taser International, which has courted hospitals as a
lucrative new market.

Ive worked in systems
where everyone has a firearm and an intermediate weapon, and
Ive worked in systems where a call to security meant
the plumber and every able-bodied man would respond,
said David LaRose, past president of the health care
security association. How much has your system thought
about safety and security? In some places thats a 2 or
3; in some places its a 10.

After Mr. Peans shooting, St.
Josephs chief executive, Mark Bernard, said the
officers were justified. The hospital said it
was reviewing its practices but declined to respond to
questions. The Houston Police Department, citing an internal
investigation, declined to comment or to make the officers
available for interviews, and released only a heavily
redacted version of its report on the shooting. This account
is drawn from a review by federal health investigators,
medical records, criminal complaints and interviews with
medical personnel and family members.

Mr. Pean had expected an apology after
the shooting. Instead, during four days in intensive care,
prosecutors charged him with two counts of felony assault on
a police officer. They accused him of attacking with four
deadly weapons  an unspecified piece of
furniture, a wall fixture, a tray table and his
hands.

James Kennedy, a lawyer representing
Mr. Pean, says his client disputes that he was the aggressor
and other allegations by the police, but cannot discuss
specifics until the charges are resolved. His family has
filed complaints with the Justice Department and health care
regulators, including the Centers for Medicare and Medicaid
Services, which provides funding to most American
hospitals.

After an emergency investigation, the
Medicare agency faulted St. Joseph for the shooting, saying
it had created immediate jeopardy to the health and
safety of its patients. Threatening to withdraw
federal money, the agency demanded restrictions on the use
of weapons.

A family with Haitian and Mexican
roots who settled in McAllen, Tex., the Peans were shocked
that Mr. Peans effort to get medical aid ended so
badly. Though his father, Harold Pean, and a half-dozen
other relatives are physicians, they said they had no idea
that guns could be used against patients. After watching the
nation roiled by the shootings of unarmed black men by
police officers over the last year or so, the family now
wonders whether race contributed to Alans near-fatal
encounter.

We never thought that
would happen to us, Dr. Pean said.

Im
Manic!

In his family of high-achievers, Alan
Pean (pronounced PAY-on) is the soft-spoken and mellow
middle sibling, into yoga, video games and pickup football.
Christian, 28, now a medical student at Mount Sinai in New
York, is the Type A leader; Dominique, 24, is following his
path, applying to medical school while pursuing a
masters degree. Alan, who had never been in any sort
of trouble, is probably the nicest of us three,
Dominique said.

Like many people with mental health
issues, he did not get a clear-cut diagnosis. After a brief
delusional episode in 2008, he was hospitalized for a more
severe recurrence the next year, at the end of his second
year at the University of Texas. He was kept for a week and
told that he had possible bipolar disorder, though his
symptoms did not reappear for years even after he tapered
off medication.

He was prone to bouts of sadness and
anxiety, he recalled in an interview, but had attended
college, taking breaks from time to time, and worked for a
while as a medical assistant back home in McAllen, near the
Mexican border. Though he had smoked marijuana regularly to
help tame his symptoms, he said in an interview, he quit
last summer when he enrolled at the University of Houston to
complete his bachelors degree.

Just days into the semester, though,
he barely slept and found himself increasingly agitated and
delusional.

On Aug. 26, he talked repeatedly on
the phone with his parents and brothers, who tried to calm
him but worried that he sounded disoriented. Christian had
been concerned enough that he called the Houston police to
do a welfare check on his brother at his
apartment, though no one answered the door when officers
arrived.

When Mr. Pean sounded worse in the
evening, his family summoned a fraternity brother in Houston
to take him to an emergency room; his parents would fly in
the next morning. But Mr. Pean did not wait. His mind
vacillating between the knowledge that he needed psychiatric
medication and encroaching delusions that he was a Barack
Obama impersonator or a Cyborg robot agent who
was being pursued by assassins, he said, he got into his
white Lexus and drove at high speed to St. Joseph Medical
Center, the only major hospital in downtown
Houston.

Turning into the parking lot just
before midnight, he crashed, nearly totaling his vehicle. As
Mr. Pean was helped into the emergency room and onto a
stretcher by paramedics and nurses, he recalled, he yelled:
Im manic! Im manic!

Alan Peans white Lexus. He
struck several cars after driving himself to St. Joseph
Medical Center for treatment of possible bipolar disorder.
Prosecutors later charged him with reckless
driving.

He was seen immediately by a doctor
from the trauma team to assess his injuries (scans and exams
showed none). The physicians initial note, minutes
after arrival, lists the young mans history of bipolar
disorder. His father and brother, in separate phone calls to
the emergency room, and a family friend who came to the
hospital, alerted the staff about his psychiatric issues,
they recalled.

Nonetheless, Mr. Pean was admitted for
observation to Room 834 on a surgical floor. The diagnoses:
hand abrasion, substance
abuse,
motor vehicle accident. His toxicology tests were negative
for alcohol, opiates, PCP or cocaine, records show. (They
did disclose some THC, the active ingredient of marijuana,
but the chemical remains in the body for many
weeks.)

While St. Joseph does have a
psychiatric ward, Mr. Pean was never seen by a psychiatrist
or prescribed any psychiatric medicines before the shooting.
Because he had complained of back pain, he was given
Flexeril, a muscle relaxant, which can exacerbate
psychotic
symptoms.

In interviews with the Medicare
investigators and notations in medical records, the nurses
who cared for Mr. Pean describe a man who had flashes of
lucidity, but was increasingly restless and
bizarre.

He pulled out the IV in his arm. He
thought it was 1989. He could not remember the car crash or
why he was in a hospital. But even in the throes of his
illness, he was polite. When a nurse told him to return to
his room after he repeatedly emerged naked into the hall, he
complied, she told investigators, with a Yes
maam, righty-o, O.K. maam.

No Clear
Guidance

Though the trauma team had planned to
discharge Mr. Pean that morning, his parents were so alarmed
when they arrived about 10 a.m. that they insisted a
psychiatrist see him. As they waited for doctors to discuss
their concerns, the Peans went to their nearby hotel to try
to rent a car and drive their son to a psychiatric facility.
In their 30-minute absence, a nurse made the call to
security.

At St. Joseph Medical Center, the
security force included armed off-duty police officers as
well as unarmed civilian officers. Who responded to a call
depended only on availability, according to the
investigators interview with the chief nursing
officer.

The two men who arrived were Houston
police officers. Roggie V. Law, 53, who is white, and Oscar
Ortega, 44, who is Latino, each had decades on the force.
They supplemented their base salaries of about $64,000 by
moonlighting at the hospital. Their records were
unremarkable. Both had some commendations, and Officer
Ortega had one distant four-day suspension for failing to
submit an accident report.

Houston police officers get 40 hours
of crisis intervention training, according to the
department. The N.A.A.C.P. and the Greater Houston Coalition
for Justice, a civil rights group, have complained that
local officers too often use their weapons, and repeatedly
requested the appointment of an independent police review
board. From 2008 to 2012, there were 121 police shootings,
in which a quarter of the victims were unarmed, according to
an investigation by The Houston Chronicle.

The two off-duty officers had signed
on with Criterion Healthcare Security, a four-year-old
staffing agency based in Tennessee whose executives had
previously managed prisons and owned gyms. Their training at
St. Joseph consisted of an orientation and online
instruction, which investigators found inadequate. The
facility had no clear guidance for the role, duties and
responsibilities of the police officers they employ to
provide security services, the Medicare
investigators report said.

Like many other security firms,
Criterion encourages applications from those with law
enforcement or military backgrounds, who are trained to use
weapons and to deal with volatile situations. But working in
health care settings requires a different mind-set, security
experts emphasize.

If they come from law
enforcement or the military, I ask them directly, How
would you respond differently here than if you encountered a
criminal on a street in L.A. or when you are kicking down a
door in Iraq? said Scott Martin, the security
director at the University of California, Irvine, Medical
Center. You have to send the message that these are
patients, theyre sick, the mental health population
has rights  and you need to be sensitive to
that.

Many mental health professionals
strongly object to weapons in hospitals, saying they have
numerous other means  from talk therapy to cloth
restraints and seclusion rooms to quick-acting shots of
sedatives
 to subdue patients if they pose a danger. State
mental health facilities typically do not allow guns or
Tasers on their premises; even police officers are asked to
check weapons at the door. (Twenty-three percent of
shootings in emergency rooms involved someone grabbing a gun
from a security officer, according
to a study
by Dr. Gabor Kelen, director of emergency medicine at Johns
Hopkins Medical School.)

Uniforms and weapons may, in fact,
exacerbate delusions, since many psychotic patients are
paranoid and, like Alan Pean, believe they are being
pursued. Anthony OBrien, a researcher at the
University of Auckland, in New Zealand, said,
Thats not a good thing, pointing something that
looks like a gun at a patient with mental health
issues.

When the two Houston officers arrived
on St. Josephs eighth floor, they headed for Room 834.
Unannounced, and unaccompanied by doctors, nurses or social
workers, they went in, the door closing behind
them.

Anxious Patient to Felony
Suspect

Racing upstairs to a Code Blue in Room
834, Dr. Arango found a cluster of about 20 Houston police
officers in the hall, according to his interview with
investigators.

When he pulled back the sheet covering
Mr. Pean, he saw that the patient was in handcuffs, his
torso dotted with Taser probes and a bloody wound on his
upper chest. It was only after the doctor noted the blood
pooling around the young man, who began shouting that he was
Superman as the physician tried to examine the wound, that
someone mentioned he had not only been hit with the Taser,
but also shot.

Take the damn handcuffs
off! Dr. Arango yelled, according to an
employee.

Mr. Peans X-ray, taken several
days after he was shot, showing bruised lungs and bullet
fragments scattered through his chest.

Initially combative and flailing, Mr.
Pean allowed a staff member to start an IV as she told him:
Its O.K., Alan, Im a nurse. Were
here to help. Within minutes, doctors placed him on a
ventilator, inserted a tube into his chest and whisked him
away for a scan, which showed that the bullet had fractured
his fifth and sixth ribs, scattering metal fragments and
causing extensive bleeding as it ripped through his
chest.

According to a statement on the Police
Departments website, Alan struck one officer in the
head, causing a laceration, when they arrived in the room.
Officer Law shocked the patient with a Taser, to no apparent
effect, and then Officer Ortega, fearing for their safety,
shot Mr. Pean.

After the shooting, his father said
officers asked over and over if Alan had a criminal record.
The next day, Christian Pean asked Sgt. Steve Murdock, a
Houston police investigator, why the officers had to shoot
his brother. In a phone conversation, Christian recalled,
the sergeant replied, Lets just say the term
Tasmanian devil comes to mind.

It was like a big
whirlwind, he went on. Everything was fair game.
Objects, chairs, eating trays, everything was being
thrown.

An ambiguity in Medicare rules allowed
Alan Peans conversion from delusional patient to
felony suspect. If a patient throws a tray at a nurse and
the staff responds with restraints, it can be considered a
health care incident. If the same patient throws the same
tray at a police officer, even one off-duty, who shoots in
response, the encounter is subject to a criminal
investigation.

While Mr. Pean was in the intensive
care unit, he was handcuffed to his bed, even though he was
heavily sedated, with a Houston police officer standing
guard. His family had to post $60,000 bail days later so he
could be discharged from the hospital.

Mr. Peans felony case is likely
to go before a grand jury in the coming months. Under the
care of a psychiatrist and on medication, Mr. Pean left
Texas behind. Living with his brother in New York, he is
finishing his degree at Hunter College and planning to go to
graduate school in public health.

But the day before Christmas, Mr. Pean
learned that prosecutors had brought a new charge 
reckless driving  against him, referring to his race
to the hospital.

Accompanied by his father, he flew to
Houston. In five hours of processing at the Harris County
Detention Center, Mr. Pean was interviewed by a detention
officer, photographed for a mug shot and fingerprinted.
Being paraded around was really stressful, he
said. Did they not understand what Id gone
through? Id been shot in a hospital room by an
officer.